En Ukraine ?

Lessons learned from the war in Ukraine for the anesthesiologist and intensivist: A scoping review

Jarrassier A. et Al Anaesth Crit Care Pain Med. 2024 Jul 30;43(5):101409.

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Un point de situation particulièrement intéressant qui met en avant la nécessité de prendre en compte les spécificités de cette guerre à haute intensité: De nouvelles modalités lésionnelles notamment par les armes thermo-bariques, les difficultés de l'établissement d'une chaîne maîtrisée de prise en charge des blessés avec la réapparition du train comme vecteur d'évacuation, bien souvent la nécessité de porter la chirurgie au plus près des combats en s'appuyant sur les hôpitaux d'infrastructures, la difficulté de l'approvisionnement notamment en dérivés sanguins, la réapparition de la discussion sur le garrot, la nécessité de disposer d'équipes parfaitement formées et entraînées pour intervenir dans de telles conditions, la place tout à fait particulière et prééminente des anesthésistes-réanimateurs dans de telles situations.

Une bonne partie de ces constatations avaient été faites notamment lors de la crise COVID (histoire de l'EMR SSA de Mulhouse puis dans les DOM). Oui mais elles ont été oubliées noyées dans le quotidien. 

 

Background

The war in Ukraine provides purposefully anesthesiologists and intensivists with important data for improving the management of trauma patients. This scoping review aims to investigate the specific management of war-related trauma patients, during the war in Ukraine, through an objective and comprehensive analysis.

Methods

A comprehensive search of the Embase, Medline, and Open Grey databases from 2014 to February 2024 yielded studies focusing on anesthesia and surgery. These studies were assessed by PRISMA and STROBE criteria and needed to discuss anesthesiology and surgical procedures.

Results

Of the 519 studies identified, 21 were included, with a low overall level of evidence. The studies covered 11,622 patients and 2470 surgical procedures. Most patients were Ukrainian men, 25–63 years old, who had sustained severe injuries from high-energy weapons, such as multiple rocket systems and combat drones. These injuries included major abdominal, facial, and extremity traumas. The surgical procedures varied from initial debridement to complex reconstructions. Anesthesia management faced significant challenges, including resource scarcity and the need for quick adaptability. Evacuations of casualties were lengthy, complex, and often involved rail transportation. Hemorrhage control with tourniquets was critical but associated with many complications. The very frequent presence of multi-resistant organisms required dedicated preventive measures and appropriated treatments. The need for qualified human resources underscored the importance of civilian-military cooperation.

Conclusion

This scoping review provides original and relevant insights on the lessons learned from the ongoing war in Ukraine, which could be useful for anesthesiologists and intensivists.